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In this chapter we address the problematic nature of altruistic motivation, commonly required of surrogate mothers, live organ donors, clinical research participants and health professionals. Altruism, understood as involving a desire to help others, often to a self-sacrificing degree, gives rise to various conceptual and ethical difficulties. We argue that encouraging the virtue of generosity is preferable to requiring altruistic motivation, because generosity is consistent with reciprocation as well as legitimate concern for self. A correct understanding of generosity also alleviates concerns about exploitation and commodification. Our focus in this chapter is on surrogacy, but our arguments apply to other domains as well.

Is medically assisted fertilization (with the use of in vitro technology) about “reproductive rights” or about white women's privileges? What is “choice” for white and rich women seems to become a further commodification of the body for women of color and economically disadvantaged women.

Several feminists define reproductive rights by demanding social justice and a type of support for the mothers that does not include expensive technologies, which have a problematic outcome, that of generating a divide between women in the north and women in the south of the world. Some authors also talk about a “division of labor” in reproduction.

The first part of my chapter offers an outline of the historical feminist debate over gender and technology, looking at different positions regarding biotechnologies, and reproductive technologies in a specific way. The second part presents an investigation around the (often racialized) international market of eggs and surrogate mothers in the United States, India and Eastern Europe.

The third part consists of an analysis of few recent studies about the health of women who undergo ovarian hyper-stimulation in order to give eggs as “donation” (under payment); women who offer themselves as surrogate mothers and the children who have been conceived with in vitro fertilization, specifically with heterologue forms (egg donation or surrogate motherhood).

Russia is one of the few countries where surrogacy is both legal and regulated. Still, volatile legislation and the lack of public acceptance of the practice make surrogacy an experience that is hard to navigate. This chapter presents an exploration of the meanings Russian surrogates attach to their work, remuneration for it, and their relationships with intended parents. Drawing on 23 semi-structured interviews with surrogates, we find that while Russian surrogates frame surrogacy as a job and engage in calculations of a fair price for their services, they provide unrequited care for intended parents and their children and embed surrogacy in the context of their motherhood as a way to provide and care for their own children. In this, Russian surrogates occupy the typical position of a post-Soviet ‘mother-worker’.

This chapter examines how lawmakers had to grapple with whether and how to regulate medically assisted reproduction after the 1988 Baby M court case in the United States propelled surrogate motherhood and related reproductive technologies onto the public policy stage. The chapter compares the public policy approaches of two countries, France and Germany, with the regulatory structures in the United States where the Baby M court case that garnered international attention took place. Specifically, the chapter provides an in-depth examination of the legal and historical contexts of each country's policy approaches in the form of existing national marriage, family, and adoption laws as well as policies regulating human reproduction. Lawmakers' task became even more pressing once citizens began using the court system and traveled abroad to either gain access to proscribed technologies or use them for a lesser fee elsewhere. As a result, Germany developed one of the most restrictive national laws in the world while France established certain legal proscriptions, which are still more far-reaching than the regulatory structures in the United States. Along the way, this developing policy area contributed to the creation of international frameworks governing medically assisted reproduction and the development of national bioethics advisory councils.

Surrogacy is a practice that requires the participation of multiple social actors: sperm and/or egg donors, intended parents (IPs) and gestational carriers (GCs). The data were collected during a research on US surrogacy conducted in Southern California between September 2017 and January 2020. The study involved IPs, GCs and the clinical and hospital staffs of a fertility clinic and six hospitals. In this contribution, I will read surrogacy as a sophisticated interweaving of relationships (Berend, 2016a) that is activated thanks to the support of artificial reproductive technologies (ARTs). I will analyze the surrogacy pregnancy not exclusively as an organic process, but, following Elly Teman (2009) and Zsuzsa Berend (2016a) insights, I will read it as a choral project shaped by all the actors directly or indirectly involved in it. I will show which rituals are practiced during the surrogacy pathway, and in particular, I will pay attention to some specific aspects that are invested by particular meaning such as ultrasounds, rooming-in, breastfeeding and the ‘skin-to-skin’ practice.

This chapter examines the emergence of India as a site for surrogacy, which has led intended parents from all over the world to contract with Indian gestational surrogates to carry “their” babies for them. Through participant observation in a surrogacy workshop, interviews with American intended parents, and interviews with Indian surrogates, I show how ideologies of normative, nuclear families built around genetically similar children, drives American consumers' desires to seek fertility intervention, and, finally, surrogacy. In India, gender ideologies shape the contours of an inexpensive, compliant labor force of surrogate mothers.

This chapter examines how women deploy gendered motherhood norms to publicly challenge abortion stigma. Drawing on a sample of 41 abortion stories from women living in Tennessee, I find that women evoke notions of intensive, total, and idealized motherhood in order to manage and challenge the stigma of an abortion. A large proportion of these stories were written by married mothers who emphasized their identities as good mothers and wives. A close qualitative analysis of these trends reveals two dominant forms of recasting abortion. First, abortion is framed as an extension of total mothering to spare an unborn baby from risky health conditions. Part of this includes casting abortion as an often-necessary choice in order for a woman to develop into the perfect mother for the benefit of her children – altruistic self-development. Second, abortion is construed as a form of maternal protection of current children to continue intensively mothering them. Both themes speak to women’s strategies for reframing abortion as a health practice to promote the well-being of children. These findings have implications for the study of medical stigma, reproduction, and the impact of gender ideals on women’s health choices.